Different Types Of Hospitals Research Articles

Fourth international study of infarct survival: Protocol for a large simple study of the effects of oral mononitrate, of oral captopril, and of intravenous magnesium

The fundamental aim of the International Studies of Infarct Survival (ISIS) collaborative group is to assess reliably the balance of any benefits and risks for widely practicable treatments that might produce moderate but worthwhile mortality reductions in patients with suspected acute myocardial infarction. Substantial numbers of lives might be saved by such treatments, but benefits of the size that can realistically be expected may be reliably detected only by randomized trials involving some tens of thousands of patients. In order to recruit such numbers, ISIS involves almost no extra work for collaborators: hence, busy general hospitals—where the majority of acute myocardial infarction patients are actually treated—can take part easily. The ability of the ISIS trials to yield clear, reliable answers depends entirely on the collaboration of many doctors and nurses in the participating hospitals. For this reason, publication of the final results is in the names of all the collaborators. All patients, high risk as well as low risk, presenting within 24 hours of the onset of suspected acute myocardial infarction are eligible for ISIS-4, provided that the responsible physician does not initially consider there to be any clear indications for, or clear contraindications to, any one of the trial treatments—nitrate, angiotensinconverting enzyme inhibitor, or magnesium. Patients are randomized between 1 month of oral controned-release mononitrate or placebo; between 1 month of oral captopril or placebo; and between 24 hours of intravenous magnesium or open control (i.e., no infusion). (Patients who are to be given intravenous or other non-trial nitrate for just a few days can still be entered.) In this trial, 3 quite different treatments will each be evaluated. At first glance, this may appear to complicate the results, but in fact appropriate statistical analysis of this “factorial” design will allow all patients to contribute fully to assessment of the separate effects of each treatment (while also providing important information about the combined effects). Apart from giving the trial treatments, all other aspects of individual patient management are left entirely to the responsible physician to decide. For example, previous trials in suspected acute myocardial infarction have shown that, for many categories of patients, antiplatelet and fibrinolytic therapy can save lives. Hence, most collaborating doctors will wish to give antiplatelet therapy routinely and to start fibrinolytic therapy in many of their patients before randomizing them in ISIS-4. Some physicians may also wish to use certain other treatments (such as intravenous β blockers, anticoagulants) routinely in particular categories of patients. There are no restrictions on this in ISIS-4. Thus, ISIS-4 will provide good evidence about the effects of adding the trial treatments to various standard treatments. By including many different types of patients from many different types of hospitals with a wide variation in ancillary management (which is in any case unavoidable), the ISIS-4 results will be of direct clinical relevance to the heterogeneous realities of clinical practice worldwide.

Pattern of Diagnostic Procedures in Radiology in the Netherlands

Data have been evaluated from an investigation of the pattern of diagnostic procedures in 49 hospitals of different types in the Netherlands. It appears that the number of examinations of all kinds increased from 1986 to 1988 by 10%. The increase in the total collective dose was 14%. The largest mean doses per investigation were found under the age of 5 and between the ages of 25 and 50. These doses arise from examinations with exposures far higher than 1 mSv per examination such as stomach, lumbar spine and IVP investigations as well as CT scans of the brain. A more critical approach to justification and optimisation techniques for those examinations alone is of great interest as to reduce the dose caused by the medical applications of radiation.

Cancer staging may have different meanings in academic and community hospitals

We investigated differences in lung cancer care and outcome between academic and community settings for all lung cancer patients diagnosed during 1973–1976 in New Hampshire and Vermont. Trained abstractors reviewed hospital charts to record personal, diagnostic, and clinical information, and survival was determined for all patients through the end of 1979. Patients diagnosed in university hospital cancer centers underwent more staging procedures and tended to be assigned to a higher stage than similar patients diagnosed in community hospitals. When tumor stage was considered as a covariable in a survival analysis, these patients appeared to have a lower mortality rate both for non-small cell tumors (mortality rate ratio, 95% confidence interval = 0.81, 0.71–0.91) and for small cep tumors (0.71, 0.55–0.91). When functional status rather than tumor stage was used to adjust for disease severity, there was no apparent suvival advantage for university patients with non-small cell cancer (0.96, 0.85–1.09) and the lower mortality for small cell cancers (0.76, 0.59–0.97) was attenuated, although still statistically significant. We conclude that inconsistently-collected data on clinical stage can complicate comparisons of prognosis between cancer patients from different types of hospitals and that measures of performance status may be more useful indicators of disease severity in population based studies.

尿路分離菌におけるニューキノロン系抗菌薬に対する耐性菌出現状況

There is concerned that the new quinolone-resistant strains have increased along with its widespread usage. We analysed the annual changes in frequency of ofloxacin-resistant strains isolated from urine in the past four years at two different types of hospitals, department of urology in Sapporo Medical College and Muroran City Hospital, since the usage of these agents seem to be related to the annual changes of the frequencies. The results were summarised as follows: 1) In the two hospitals, drug volume of the new quinolones had been increased, in particular, the past six years from 1984. 2) The annual changes in frequency of ofloxacin-resistant Staphylococcus aureus have been increasing from 0 to 41.2 percent in Sapporo Medical College and 16.7 to 96.7 percent in Muroran City Hospital. The frequency of ofloxacin-resistant Pseudomonas aeruginosa also have been increasing from 24 to 66.7 percent in Sapporo Medical College and 37.5 to 81.8 percent in Muroran City Hospital. 3) The frequency of ofloxacin-resistant indole positive Proteus spp. and Serratia marcescens for four years at Sapporo Medical College (indole positive Proteus spp.: 0-1.8 percent, Serratia marcescens: 10-43 percent) was very different from that at Muroran City Hospital (indole positive Proteus spp.: 65-82 percent, Serratia marcescens: 71-100 percent). The difference seems to be caused by the hospital acquired infection.

Residents' hours and supervision.

One year of graduate medical education, the internship, had become the norm for graduates of most U.S. medical schools by 1920, and subsequently was adopted by most states as a criterion for licensure. The original concept of a "resident physician" carried with it responsibility for patients 24 hours per day, seven days per week. Recent public and media attention to the issues of residents' supervision and working hours has led to governmental efforts to restrict their hours and set minimum requirements for supervision. New York is the first state to impose specific requirements. The New York recommendations have implications for the concept of graded responsibility for residents, for learning the natural course of illness, and for the need to provide service in hospitals. Further, the recommendations raise four objections: they do not recognize differences by type of specialty or year of training; they might affect the length of time needed to acquire aggregate clinical skills; they affect different types of hospitals differently; and they would have a major effect on physician manpower. Hospitals and residency programs will face several difficult choices in responding to the regulations. To provide its members with guidelines for action, the Executive Council of the Association of American Medical Colleges has issued recommendations for residency hours and supervision, including the use of an 80-hour work-week averaged over four weeks, the continued use of graded supervision of residents in emergency rooms and in inpatient and ambulatory settings, and control of housestaff moonlighting.

Controlling Medicaid costs in hospitals.

When the Medicaid program began over two decades ago, states paid hospitals for providing service to Medicaid recipients on the same type of cost-reimbursement basis as did other third-party payers reimbursing hospital expenses for the general population. The intent was to weaken the dependence of the poor on public hospitals and to provide access to mainstream medicine. Since then, the need to control state spending generally, and Medicaid spending in particular, has led most states to constrain Medicaid payments to hospitals by implementing some form of prospective payment system. To the extent Medicaid hospital payment rates tend to be lower than the payment rates hospitals receive for Medicare and private patients, many hospitals may be less willing to take Medicaid patients, and access to care for those patients may become increasingly limited. The purpose of this DataWatch is to identify how Medicaid utilization differs from that of the general population and to discuss the implications of those differences for issues of access and the prospects of future Medicaid cost-control efforts. We use data from the 1984 American Hospital Association (AHA) annual survey to examine hospital utilization patterns of Medicaid recipients. Of the 7,110 hospitals surveyed in the 1984 AHA annual survey, we selected short-term, general medical and surgical hospitals located in the fifty states and the District of Columbia. This sample consisted of 5,645 hospitals, 79.4 percent of the total survey universe. Hospitals with implausible data, such as if Medicaid admissions exceeded days or total admissions exceeded days, were excluded. This reduced the sample by 12 percent to the 4,987 hospitals on which this analysis is based. The first section provides a brief overview of the distribution of different types of hospitals by geographic region to provide a general

Points: Mortality from myocardial infarction in different types of hospitals

Points: Mortality from myocardial infarction in different types of hospitals

Measuring hospital performance: A non-parametric approach

In this paper a technique for assessing the relative performance of firms is introduced and applied to a sample of hospitals in California. Hospitals are compared on the basis of their relative technical efficiency. The reference technology is constructed from observed outputs and inputs (including physicians) using programming techniques, and efficiency is assessed relative to the frontier of the technology using measures similar to those suggested by Farrell. The technique used here imposes no prespecified functional form, allows for multiple outputs and inputs (allowing for differences in case mix), and yields information on the productive performance of individual hospitals. This technique can also be used to determine whether different types of hospitals use different technologies. Our results, although illustrative rather than definitive, suggest that ownership affects ‘efficiency’ as measured here: public and NFP hospitals have ‘different’ best practice frontiers, and public hospitals appear to use relatively fewer resources. These results could reflect differences in quality of care by ownership.

The accuracy of retrospective chart review in measuring nosocomial infection rates. Results of validation studies in pilot hospitals.

To measure the accuracy and consistency of a standardized method--retrospective chart review (RCR)--for estimating nosocomial infection rates (NIRs) in individual hospitals, the authors performed a series of pilot studies in four hospitals of different types. In comparison with a standard based on diagnoses made by physician-epidemiologists supervising intensive prospective data collection teams, the RCR method was found to have an average sensitivity of 0.74 (+/- 0.02 SE; range 0.69-0.78) and an average specificity of 0.964 (+/- 0.002; 0.945-0.991). These values were comparable to those of the physician-epidemiologists' diagnoses and varied less among the hospitals. Two independent teams of chart reviewers were found to have similar levels of sensitivity and specificity, and the reliability of diagnosis at the level of the individual chart reviewer averaged 0.94. In a restudy at one of the pilot hospitals at the midpoint of the actual Medical Records Survey (MRS), there was a substantial increase in sensitivityand a slight increase in specificity as a result of improvements made in the RCR method after the original pilot studies.

A predictive and descriptive model of interns' hospital selections

This paper examines the differences among medical students who have chosen different types of hospitals for internship training. The criterion variable of a medical student electing to take internship training in a government, private, public, or university hospital is analyzed using admissions, medical training, and practice data as independent variables. Multiple discriminant analysis is employed to evaluate the profiles of physicians who have taken internship training in the different types of hospitals. Classification rates were found to be somewhat accurate. Computer graph plots of discriminant analysis mappings are used to depict differences among the hospital-based internship groups. The results of applying these techniques and methods are of value for more efficient hospital administration.

Storage and retrieval of radiographic images.

Storage and retrieval of radiographic images was studied to quantify existing procedures and determine the applicability of new technology. Storage practices were found to be consistent among different types of hospitals. About one third of American hospitals have serious problems, particularly lack of space. Most hospitals save radiographs 4-7 years after the latest examination, but one third fall outside this range. It does not appear that there is near-term technological solution for radiographic storage problems.

Costs and Quality of Care in Different Types of Hospitals

American hospitals vary by type of ownership, type of patient treated, average length of stay, size, scope of services offered and teaching programs. This paper re views what is known about how these differences are related to costs and quality of care. The range of costs per case varies widely by type of hospital and size of hospital. Larger general hospitals have lower unit costs, while specialty and teaching hospitals, large or small, have higher costs than general hos pitals. Studies are needed to answer many questions about costs of hospitals, standardizing for case mix, quality of care, ownership, and organization.

Nursing Personnel in General Hospitals

IN THE SUMMER Of 1943, the Procurement and Assignment Service of the War Manpower Commission sent a questionnaire to all hospitals registered by the American Medical Association. The questionnaire was designed to obtain information regarding the professional personnel, both medical and nursing, in hospitals in order to appraise the current needs of the hospitals and to secure an equitable distribution of interns, residents, and nurses. The 1,665 general and related special hospitals which returned adequate questionnaires comprised 40 per cent of the 4,200 such hospitals in the country and accounted for 60 per cent of the patient census. A higher per cent of the hospitals with schools and of the large hospitals both with and without schools returned questionnaires. Table I shows the per cent of hospitals and the per cent of patient census represented by the returned questionnaires for hospitals of different types, sizes, and geographic area. Information was obtained about the number